Survey: Physician Confusion Over Covered California Plans Negatively Impacted Patient Care May 2, 2014 Advocacy, CMA, Covered California all products clauses, Covered California, AB 2400 0 The California Medical Association (CMA) recently surveyed more than 2,300 physicians about their contracting experience with Covered California plans. 80% of respondents reported that they were confused about their participation status in a Covered California plan and that this has negatively impacted patient care. The survey findings showed that health plan contracting practices—such as all products clauses, vague and confusing contractual language and silent amendments—are the primary contributors to the current state of network confusion for providers. Survey respondents also report that the confusion has negatively impacted patient care in their practice and has led to the loss of patients. With roughly 1.4 million Californians newly enrolled in Covered California products since January, it has been difficult for both physicians and patients to find out who is in and out of the narrow provider networks offered by Anthem Blue Cross and Blue Shield of California. Much of the uncertainty over whether a physician is in a Covered California panel or not has been caused by intentionally vague “all products clauses” in provider contracts that bind them to participating in unspecified current and future products offered by the health plans. Also contributing to the confusion, is a loophole in California’s law, which gives health plans the ability to make unilateral changes to providers PPO contracts and consider a provider’s lack of response as acceptance of the changes, also known as a “silent amendment.” This is unlike the laws governing health maintenance organizations (HMOs), which require any change to a contract to first be negotiated and agreed to by the provider. With the rollout of Covered California, some health plans have used the PPO loophole to push many physicians unknowingly into additional product networks without their knowledge. The result has been that many physicians do not realize they have been added to lists of Covered California providers. The potential long-term impact of such contracting practices is also troubling. The market power of certain health plans in parts of California give them the ability to effectively force physicians into accepting exchange products by making participation in all of their broader commercial products contingent on exchange product participation. SFMS physicians have advocated in support of CMA-sponsored bill AB 2400 (Ridley-Thomas), which has passed out of the health committee with overwhelming support. AB 2400 will prohibit contracts issued, amended, or renewed after January 1, 2015, from including a provision that terminates providers’ participation in the contract when the provider exercises the right to negotiate, accept or refuse a material change to the contract. It will also prohibit plans from requiring participation in unspecified current and future products or product networks, unless the plan discloses the reimbursement rate, method of payment and any other contract terms that are materially different from those of the underlying commercial agreement. Click here for information about AB 2400. Click here to view the results from the CMA survey. Comments are closed.
